Division of Global Health

The Division of Global Health (DGH) at MassGeneral Hospital for Children is led by Division Chief Dr. Patricia Hibberd and includes energetic faculty members and senior research fellows. The Division's primary mission is to build and foster international partnerships for interdisciplinary research, education and service to reduce health disparities and achieve optimal health for children and adolescents in resource-limited settings of the developing world. Our multidisciplinary team of faculty has significant experience working in the global arena, and in mentoring and teaching future leaders in global health.

Faculty in the Division of Global Health are tackling some of the most perplexing challenges in global health delivery and care, prevention and capacity-building in countries around the world. Please read about them in greater detail in "Research Projects."

Dr. Hibberd is Chief of the Division of Global Health at MassGeneral Hospital for Children. She received her PhD degree in Information Science/Epidemiology in 1978 and her MD degree from Harvard Medical School in 1986. She trained in internal medicine and infectious diseases at Massachusetts General Hospital. In addition to her clinical duties as an infectious disease consultant, her research focuses on the prevention and treatment of childhood pneumonia, neonatal sepsis and diarrhea – the leading killers of children under age 5 worldwide. Her work based in India is funded by NIH/NICHD’s Global Network for Women and Children’s Health Research and her work in Africa is supported by various funders. Dr. Hibberd also leads a clinical and translational research effort on innovative ways to prevent and treat infectious diseases. She serves as principal investigator on a K24 grant to mentor the next generation of leaders in global health and has three U01 grants from the NIH to study the mechanisms and therapeutic effects of probiotics, their effect on the gastrointestinal and respiratory microbiome and their potential as vaccine adjuvants in the United States and globally. Dr Hibberd is also a recipient of multiple awards to develop and test technologies to level the playing field and ensure that optimal quality of care be provided to the world’s children. Dr. Hibberd is a Paul G. Rogers Society Ambassador for Global Health Research.

Core Faculty

Lauren Arlington, MPH, BS

Lauren is a Biostatistician and Epidemiologist for the Division of Global Health. She received an MPH from Boston University School of Public Health and during the course of her degree worked with Dr. Hibberd on an international practicum studying household air pollution in Nagpur, India. Since graduating, Lauren has worked full time at the Division of Global Health where she continues to pursue her interests in global maternal and child health. She received the NEWAID grant to conduct a study in India on the association between household air pollution and pneumonia in young infants and has presented on the topic at international conferences. Lauren has also expanded her skills and interests by working in a multifaceted way on past and current studies. She provides statistical support on studies of probiotics and the Helping Babies Breathe initiative in Tanzania and Ghana and assists in the design and conduct of studies of novel diagnostic imaging.

Chris Botelho, MPH

Christine is a senior project manager in the Division of Global Health at Massachusetts General Hospital for Children. She provides regulatory oversight for the research in the Division, particularly for those studies conducted internationally or under IND. In this role, she assists researchers with regulatory correspondence (IRB, FDA, etc), grant and report writing, as well as with the implementation and day-to-day operations of clinical trials. Since 2008, she has provided support to the Nagpur, India research site of the Global Network for Women’s and Children’s Health Research, a NIH-sponsored collaboration between U.S. investigators and foreign investigators in developing countries. She received her MPH in Epidemiology and Infectious Disease from Yale University and has been working in Clinical Research since 1999. Previously, she worked as an Infection Control Coordinator and Clinical Microbiologist.

Dr. Gupta is an attending physician in the Division of Adolescent Medicine at MassGeneral Hospital for Children. She completed her medical school and residency in pediatrics in India, where she gained a lot of experience working in the field with the Integrated Child Development Services. She furthered her expertise in the field and developed an interest in adolescent health while working in Australia and England, where she also obtained Membership of Royal College of Physician UK. Dr. Gupta subsequently completed her pediatric residency and a fellowship in adolescent medicine from Tufts Medical Center. She also received a Masters in Public Health with a concentration in International Health from the Harvard School of Public Health. After serving as Faculty in the Division of Adolescent medicine at Tufts University School of Medicine she was recruited to start the “Center for Adolescent Health” at Milford Regional Medical Center, a large community hospital in Central Massachusetts, where she served as medical director from 2002-2012. Dr. Gupta is currently involved in reproductive health and nutritional issues in adolescents and in providing comprehensive adolescent health services in resource-limited settings and in the United States. She is interested in developing integrated services for adolescents in developing countries that will focus on improving reproductive health and nutrition in the context of the culture and the community. Dr Gupta is the principal investigator in a study being conducted in two states in India entitled “Evaluating the prevalence and causes of anemia amongst females in India using needleless technology.” She is involved in teaching of residents and medical students at MGH and Harvard Medical School and is also co-editor of the “MassGeneral Hospital for Children Handbook of Pediatric Global Health”

Dr. Harris is a pediatric infectious disease specialist with an interest in host-pathogen interactions in bacterial enteric infections. He received his M.D. from Duke University and M.P.H. from the Harvard School of Public Health. He was a pediatric resident and chief resident at the Massachusetts General Hospital and was a pediatric infectious disease fellow at Boston Children's Hospital. To better understand the human immune response to cholera and enteric fever, our group has been working in collaboration with investigators at the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh (since 2003) and in collaboration with investigators at Partners In Health in Haiti (since 2010).

Dr. Kasper is an attending pediatrician at MassGeneral Hospital for Children, Instructor at Harvard Medical School and Board Member of Doctors for Global Health. Her diverse global health expertise includes health service delivery; rural community development; complex humanitarian emergencies; field-based operations research; health system strengthening; and curriculum development, training and mentorship of community health workers and other health professionals. She has worked in numerous countries, including El Salvador, Mexico, Haiti, India, Mozambique and South Africa. She received a combined BA/MD with honors from Boston University/Boston University School of Medicine and an MPH from Boston University School of Public Health. Dr. Kasper works clinically at the MGH Chelsea HealthCare Center; co-directs “The Introduction to Social Medicine and Global Health” at Harvard Medical School; and is the Chair of the HMS Faculty Advisory Committee on Global Health. She was the recipient of the HMS/HSDM Deans’ Community Service Lifetime Achievement Award for her nearly two decades work with Doctors for Global Health. She was also a nominee for the HMS Donald O’Hara Faculty Prize for Excellence in Teaching. She is a co-editor of the MGHfC Handbook of Pediatric Global Health.

Dr. Kao is currently the co-director of the Pediatric Hospitalist Division at MassGeneral Hospital for Children, and she attends on both the Adult Internal Medicine and Pediatric services at Massachusetts General Hospital. She has previously worked on various projects, most recently in Ecuador as part of an effort to increase services to developmentally disabled children. She has also led a team in a healthcare project for children in Panama supporting a local NGO, Pro Ninez. In 2005, she worked on behalf of the Tsunami Relief effort as part of Project Hope. Dr. Kao was also a Mass General Durant Fellow in Refugee Medicine traveling to Rwanda, where she started up a health center and hospital in a refugee camp working with American Refugee Committee and UNHCR in 2007-2008. She has also worked in Romania and Vietnam, and she was a pediatric clinical advisor to the Cambodian Health Committee. Domestically, Dr. Kao has worked at a Navajo Reservation in Chinle, AZ, and an urgent care clinic in Chelsea, MA, serving a population largely consisting of immigrants from Latin America. She received the University of Washington School of Medicine Alumni Humanitarian award in 2007. Dr. Kao received her medical degree with honors from the University of Washington, and completed her combined residency in internal medicine and pediatrics at Massachusetts General Hospital, MassGeneral Hospital for Children and Children’s Hospital Boston. She received an MPH from the Harvard School of Public Health

Peter Moschovis, MD, MPH

Dr. Moschovis graduated from the University of Chicago Pritzker School of Medicine and trained in Internal Medicine/Pediatrics at Massachusetts General Hospital. He completed clinical training in pulmonary and critical care medicine in the Harvard Combined Pulmonary/Critical Care Fellowship, and is currently a global health research fellow in the Division of Global Health under the mentorship of Dr. Patricia Hibberd. Dr. Moschovis’ global health research focuses on treatable risk factors for childhood pneumonia and adult chronic respiratory disease. Together with collaborators in Uganda, he is principal investigator for a study of risk factors for poor outcomes in childhood pneumonia. He is also involved in a training initiative for pulmonary medicine in Uganda.

Brett D. Nelson, MD, MPH, DTM&H

Dr. Nelson is an attending pediatrician and global health faculty at MassGeneral Hospital for Children and an Assistant Professor at Harvard Medical School. His professional interests are health care provision, development, research, and advocacy for vulnerable populations, particularly newborns and children in settings affected by poverty, conflict, or disaster. He helped establish the nation’s first Pediatric Global Health Fellowship at Massachusetts General Hospital and was its first fellow. Dr. Nelson has advanced degrees in public health (Johns Hopkins) and tropical medicine (London School of Hygiene and Tropical Medicine). He has been involved in pediatric care, academic research, program management, and global health consultancy in dozens of resource-limited areas while working for organizations, such as the Centers for Disease Control, International Rescue Committee, International Red Cross and Red Crescent, UNICEF, Médecins Sans Frontières, Johns Hopkins, and Harvard University. Recently in Liberia, Dr. Nelson served as country’s Senior Pediatrician and as the Interim Chair of the Department of Pediatrics and Newborn Medicine for the country's sole teaching hospital. He currently leads newborn and child health programs in several countries in East and West Africa. Dr. Nelson works clinically as a newborn hospitalist, and he co-directs a course at Harvard Medical School on tropical diseases and global health. He is the Editor of the new Wiley-Blackwell medical textbook, Essential Clinical Global Health.

Kate Powis, MD, MPH, MBA

Dr. Powis graduated from Medical College of Virginia and completed a combined Internal Medicine – Pediatrics Residency Program at Massachusetts General Hospital and Boston Children’s Hospital. During residency she worked with the International Organization of Migration to rehabilitate the primary health care system in the Province of Aceh, Indonesia following the devastating earthquake and tsunami of 2004. This project, conducted in coordination with the Indonesian Ministry of Health and local health authorities, led to a second focused project addressing the high maternal and neonatal mortality rate in the Province. After residency, Dr. Powis completed a Global Women’s Health Fellowship through the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital. During her fellowship, she obtained her MPH at Harvard School of Public Health. Since 2008, Dr Powis has Botswana with Botswana Harvard AIDS Institute Partnership, spending six months out of each calendar year in Botswana. She focused on research projects primarily involving HIV-infected women, pregnancy, pregnancy outcomes and the health of children born to HIV-infected mothers. Recently, she served as the Principal Investigator on a CDC funded study, carried out in collaboration with Botswana Ministry of Health to investigate the determinants of malnutrition in children under the age of 5. When she is in Boston, she attends on the Adult Inpatient Medicine Service, Pediatrics and MGH Chelsea Urgent Care.

Kevin Schwartz, MD

Dr. Schwartz is a Pediatric Hospitalist and Pediatric Emergency Medicine faculty member at MassGeneral Hospital for Children. He attended the University of Massachusetts Medical School, completed his Pediatric Residency at MassGeneral Hospital for Children, completed a Pediatric Emergency Medicine Fellowship at Boston Medical Center and completed one year of clinical training in Pediatric Hematology/Oncology at Hasbro Children's Hospital before returning to MGHfC. Dr. Schwartz is co-founder and US Executive Director of The Child is Innocent, a non-governmental organization that provides educational opportunities and leadership development training to children from Northern Uganda. During his Emergency Medicine fellowship, he conducted research in innovative curricula to prepare US pediatric and emergency medicine residents for clinical work abroad. He has worked in Liberia to expand pediatric medical student and resident education in collaboration with pediatric faculty there. His current research interests include medical education in global health and the acute management of tropical disease and the adaptation of pediatric oncology treatment protocols to low and middle-income health care settings.

Childhood Pneumonia and Neonatal Sepsis in India

Patricia Hibberd, MD, PhD, is the Principal Investigator of the Massachusetts General Hospital’s NICHD funded Global Network Site, in collaboration with Archana Patel, MD, the SFI for the Lata Medical Research Foundation in Nagpur, Maharashtra, India. They are currently participating in multiple Global Network common protocols including The Maternal Newborn Health Registry, a prospective, population-based study of pregnancy and neonatal outcomes. Drs. Hibberd and Patel are working innovate m-Health and other point of care diagnostics to reduce childhood pneumonia and neonatal sepsis. They are also studying innovate ways to assess gestational age at birth, to help direct care to preterm babies.

Brett D. Nelson, MD, MPH, DTM&H, and collaborators are committed to addressing the leading causes of mortality during the most dangerous time in life: the few moments around birth. Each year, nearly 3 million newborn deaths and 3 million stillbirths occur worldwide. The vast majority of these perinatal deaths occurs in low- and middle-income countries and are most commonly a result of asphyxia (intrapartum-related complications), infection, prematurity and birth complications. Nearly all of these deaths are preventable. However, there has been limited success in implementing proven interventions in resource-limited settings. A critical next step in reducing millions of annual perinatal deaths is assessing barriers to the successful introduction and sustainability of proven interventions. With this aim in mind, Dr. Nelson is currently leading the critical evaluation of country-level newborn training programs in East and West Africa.

Analysis of the Effects of In-Utero Antiretroviral Exposure on Longitudinal Growth of HIV-Exposed Uninfected Infants in Botswana

Kate Powis, MD, MPH, MBA, is an investigator in two NIH-funded Botswana-based randomized controlled trials which investigated mother-to-child transmission (MTCT) of HIV. She is using data collected in the Mashi and Mma Bana studies to evaluate any difference in growth patterns over the first 24 months of life for HIV-exposed uninfected infants born to HIV-infected women who either took three antiretroviral drugs or zidovudine during pregnancy for prevention of MTCT.

Research on the Issues Surrounding HIV-Infected Pregnant Women and Their Infants:

The Mpepu study initiated enrollment in May 2011 and with over 2,500 HIV-infected women and their HIV-uninfected infants enrolled thus far and total planned accrual of approximately 3,700 mother-infant pairs. Infants will be randomized to daily cotrimoxazole (CTX) or placebo from as early as 14 days of life through 15 months of life. For mothers opting to breastfeed, infants will be randomized to 6 or 12 months of breastfeeding. Infant HIV-free survival will be analyzed at 18 months of life based upon randomization to CTX or placebo. Additionally, 2010 revised World Health Organization guidelines recommending 12 months of breastfeeding in resource-limited settings, the Mpepu study will be the first randomized controlled trial to provide evidence-based outcomes of HIV-transmission rates and HIV-free survival outcomes comparing 6 months to 12 months of breastfeeding.

Early Infant Treatment: HIV-exposed infants born in selected hospitals in Botswana will undergo HIV testing on day of birth. Any infants found to be HIV-infected will be initiated on treatment within 24 hours of a positive result and followed through at least two years of life. This study will establish PK levels of antiretroviral drugs in the first weeks of life in order to devise safe dosing guidelines and will explore whether or not early initiation of antiretroviral treatment in HIV-infected infants prevents the establishment of viral reservoirs.

Determinants of Malnutrition in Botswana among Children under the Age of 5

This cross sectional study enrolled infants and children under the age of 5 attending well-child visits at government health facilities in Botswana, along with their caregivers in 2013 and 2014. Over 1,600 child-caregiver pairs were enrolled in the study. Anthropometric measures were obtained from the infant/child, their health records were abstracted and socio-demographic information was solicited from their caregiver. This study represents a collaboration between Botswana Harvard AIDS Institute Partnership, Botswana Ministry of Health and Massachusetts General Hospital. Results of the study are being used by Botswana Ministry of Health to alter national healthcare and nutrition policies. The dataset from the study is available to interested residents for smaller research projects/publications. Interested residents should contact Kate Powis at kpowis@mgh.harvard.edu.

Evaluating the prevalence and causes of anemia amongst females in India using needleless technology

Nupur Gupta MD, MPH

Anemia is a major contributor to maternal and child death. It is a preventable cause of mortality and morbidity, yet it continues to affect a third of the world’s population and causes 68 million disability adjusted life years (DALYS). The prevalence of anemia in India is staggering, with estimates suggesting that 88% of pregnant women, 55% of non-pregnant women, and 70% of children under-5 are affected. Iron-deficiency anemia increases risk of preterm labor and low birth rate, child and maternal mortality; negatively impacts the cognitive development and physical growth of children, and weakens both the mother and child's immune response to infection. Amongst adolescent girls, physical growth and menses can aggravate anemia and place young girls at risk for complications and mortality during their pregnancy. Anemia during pregnancy can contribute to maternal death by exacerbating hemorrhage, septicemia, eclampsia, and cardiac arrest. In India although anemia has long been recognized as a problem four decades of efforts have failed to make a significant impact on the burden of this disease. Also the adolescent female population has been left out of both national data collection efforts and interventions. Adolescence is an ideal time for detection and correction of anemia prior to pregnancy. In many states in India the average age at marriage for girls is 15 years old, and by 19 years of age, 36% of women have begun childbearing, making the adolescent years an essential time for intervention. Accurate measurement of anemia is essential to providing adequate care and treatment. Clinical examination and current measures employed are inaccurate and require a pinprick, which may cause pain, discomfort and increased risk of infection for the participants. There is a critical need for accurate and acceptable hemoglobin monitoring tools for resource-limited settings, accurate prevalence data in adolescent females and an understanding of the factors contributing to poor compliance of iron folic acid interventions. The Pronto-7 device (Masimo) is a FDA approved pulse oximeter that provides accurate hemoglobin estimation.

Elucidate factors contributing to the high burden of anemia, as well as reasons that current interventions are failing to achieve a significant impact.

The results of the study will help us lay the foundation for a culturally acceptable educational or incentive based program aimed toward eradication of anemia in rural female population in India. Eliminating iron-deficiency anemia in this population will help reduce maternal and child mortality.

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